Don't Procrastinate With Your Prostate

Dec. 12, 2006

By SAMI BÉG, M.D.ABC News Medical Unit

In the past, "watchful waiting" -- closely monitoring for signs and symptoms -- has often been the recommendation for many prostate cancer patients.

Now, it seems elderly men who have the beginnings of prostate cancer may do better if they receive treatment, rather than just waiting to see how their cancers progress, according to new research in the Journal of the American Medical Association.

The study, which was conducted over a 12-year period, looked at prostate cancer in 44,630 men aged 65 to 80 years.

Of the men who received radiation treatment or had their prostates removed, only 24 percent died. By comparison, in the watchful waiting group 37 percent of the men died.

These results were seen across all categories of patients, including older men, African-American men, and men with low-risk disease.

But experts continue to debate which men should be treated aggressively for prostate cancer and which men are probably better off not being treated because their cancer is slow-growing.

In general, the most benefit is seen in younger men, but this study suggests that even men aged 75-80 enjoy longer survival with treatment.

Intervention Could Help Many

Many experts say the findings could be beneficial for a number of patients.

"It is the first convincing study that treatment of screen-detected cancers is beneficial," said Dr. Eric Klein from the Cleveland Clinic. "This will put a big dent in the argument of those who advocate watchful waiting."

"Showing that treatment of men over 65 who have clinically localized prostate cancer saves lives has broad and important implications," said Dr. William J. Catalona, professor of urology and director of the Clinical Prostate Cancer Program at Northwestern University Feinberg School of Medicine in Chicago. "It suggests that watchful waiting strategies that have gained much recent attention carry a significant risk of unnecessary death from prostate cancer."

"If the results are valid, this data provides compelling evidence that local treatment is important in prostate cancer," said Dr. Howard Sandler, professor and senior associate chair of the Department of Radiation Oncology at the University of Michigan. "This study provides additional encouragement that active treatment will decrease the chance that my patients will die from prostate cancer."

Some physicians said the findings may even change the way they treat their patients.

"I will probably be more inclined to recommend treatment instead of waiting," said Dr. L. Michael Glodé, professor and Robert Rifkin Chair at the University of Colorado Cancer Center.

"Prior to this study, the only study showing a benefit for treatment was in men under the age of 65; those were the men I most strongly urged immediate treatment," said Dr. Robert E. Reiter, professor of urology and director of research at University of California at Los Angeles. "The benefit of this article is that it does suggest that treating healthy elderly men with significant tumors may be beneficial, which is nice to hear."

Some Experts Say Results Not Clear-Cut

"As much as I like the message, I remain skeptical," said Dr. Patrick Walsh from the Brady Urological Institute at The Johns Hopkins Hospital in Baltimore. He says other factors could be at play and suggests that the group receiving treatment may have been comprised mostly of healthier men.